心肌肌钙蛋白 I 与射血分数保留的心力衰竭患者心脏事件风险。

Cardiac Troponin I and Risk of Cardiac Events in Patients With Heart Failure and Preserved Ejection Fraction.

机构信息

Cardiovascular Division, Brigham and Women's Hospital, Boston, MA. (P.L.M., B.L.C., I.E.B., E.L., S.D.S., M.A.P., A.S.D.).

Division of Medicine, Akershus University Hospital, Lørenskog and University of Oslo, Norway (P.L.M.).

出版信息

Circ Heart Fail. 2018 Nov;11(11):e005312. doi: 10.1161/CIRCHEARTFAILURE.118.005312.

DOI:10.1161/CIRCHEARTFAILURE.118.005312

PMID:30571192

Abstract

BACKGROUND

Levels of cTn (cardiac troponin) are frequently elevated in patients with heart failure (HF) and reduced ejection fraction (EF) and correlate with the risk for mortality. However, factors associated with high cTn concentrations and the association with cardiovascular events in patients with HF and preserved EF are unclear.

METHODS AND RESULTS

Of 1767 subjects with symptomatic HF with preserved EF from the Americas part of the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial), 236 underwent baseline measurements of high-sensitivity (hs) cTnI using the Abbott Architect STAT assay. Baseline factors correlated with hs-cTnI levels were assessed in stepwise linear regression models and the association between hs-cTnI and adjudicated study outcomes was examined in Cox models. The median hs-cTnI concentration at baseline was 6.3 ng/L (interquartile range, 3.4-12.9 ng/L) with levels detectable in 99.2% of patients. Higher hs-cTnI concentrations were associated with male sex, black race, lower estimated glomerular filtration rate and higher NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. After multivariable adjustment, higher concentrations of hs-cTnI were associated with greater risk for the composite of cardiovascular death or HF hospitalization (69 events during mean follow-up 2.6±1.5 years): hazard ratio 1.42 (95% CI, 1.20-1.69), P<0.001 per doubling of hs-cTnI. Compared with those in the lowest quartile of hs-cTnI, patients in the highest quartile demonstrated a nearly 5-fold higher risk of cardiovascular death and HF hospitalization (hazard ratio 4.85 [1.99-11.83], P=0.001). There was no interaction between hs-cTnI and spironolactone treatment with regard to the primary composite end point (interaction P=0.94).

CONCLUSIONS

In ambulatory patients with HF with preserved EF, levels of hs-cTnI are higher in male patients with black race, lower estimated glomerular filtration rate, and higher NT-proBNP. As in those with HF and reduced EF, higher hs-cTnI levels are independently associated with risk for cardiovascular death and HF hospitalization.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov . Unique identifier: NCT00094302.

摘要

背景

在射血分数降低的心力衰竭（HF）患者中，cTn（心肌肌钙蛋白）水平经常升高，与死亡率相关。然而，与心力衰竭和射血分数保留患者的高 cTn 浓度相关的因素以及与心血管事件的关联尚不清楚。

方法和结果

在来自美洲部分的 TOPCAT 试验（醛固酮拮抗剂治疗保留心脏功能心力衰竭试验）的 1767 名有症状的射血分数保留的 HF 患者中，有 236 名患者接受了使用雅培 Architect STAT 检测的高敏（hs）cTnI 的基线测量。逐步线性回归模型评估了与 hs-cTnI 水平相关的基线因素，并在 Cox 模型中检查了 hs-cTnI 与经裁决的研究结局之间的关联。基线时 hs-cTnI 浓度的中位数为 6.3ng/L（四分位距，3.4-12.9ng/L），99.2%的患者可检测到该浓度。较高的 hs-cTnI 浓度与男性、黑种人、较低的估计肾小球滤过率和较高的 NT-proBNP（N 末端 pro-B 型利钠肽）水平相关。在多变量调整后，较高浓度的 hs-cTnI 与心血管死亡或 HF 住院的复合结局风险增加相关（平均随访 2.6±1.5 年期间共发生 69 例事件）：风险比 1.42（95%CI，1.20-1.69），每增加一倍 hs-cTnI，P<0.001。与 hs-cTnI 最低四分位数的患者相比，最高四分位数的患者发生心血管死亡和 HF 住院的风险高近 5 倍（风险比 4.85[1.99-11.83]，P=0.001）。hs-cTnI 与螺内酯治疗之间在主要复合终点方面无交互作用（交互作用 P=0.94）。